Showing papers by "Başkent University published in 2017"

Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging.

Abstract: Aims This European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases Methods and results Demographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported In addition, measurements should be normalized for body size Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (eg in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography) The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers Conclusion The conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison

Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study

Abstract: Summary Background The best available treatment against carbapenemase-producing Enterobacteriaceae (CPE) is unknown. The objective of this study was to investigate the effect of appropriate therapy and of appropriate combination therapy on mortality of patients with bloodstream infections (BSIs) due to CPE. Methods In this retrospective cohort study, we included patients with clinically significant monomicrobial BSIs due to CPE from the INCREMENT cohort, recruited from 26 tertiary hospitals in ten countries. Exclusion criteria were missing key data, death sooner than 24 h after the index date, therapy with an active antibiotic for at least 2 days when blood cultures were taken, and subsequent episodes in the same patient. We compared 30 day all-cause mortality between patients receiving appropriate (including an active drug against the blood isolate and started in the first 5 days after infection) or inappropriate therapy, and for patients receiving appropriate therapy, between those receiving active monotherapy (only one active drug) or combination therapy (more than one). We used a propensity score for receiving combination therapy and a validated mortality score (INCREMENT-CPE mortality score) to control for confounders in Cox regression analyses. We stratified analyses of combination therapy according to INCREMENT-CPE mortality score (0–7 [low mortality score] vs 8–15 [high mortality score]). INCREMENT is registered with ClinicalTrials.gov, number NCT01764490. Findings Between Jan 1, 2004, and Dec 31, 2013, 480 patients with BSIs due to CPE were enrolled in the INCREMENT cohort, of whom we included 437 (91%) in this study. 343 (78%) patients received appropriate therapy compared with 94 (22%) who received inappropriate therapy. The most frequent organism was Klebsiella pneumoniae (375 [86%] of 437; 291 [85%] of 343 patients receiving appropriate therapy vs 84 [89%] of 94 receiving inappropriate therapy) and the most frequent carbapenemase was K pneumoniae carbapenemase (329 [75%]; 253 [74%] vs 76 [81%]). Appropriate therapy was associated with lower mortality than was inappropriate therapy (132 [38·5%] of 343 patients died vs 57 [60·6%] of 94; absolute difference 22·1% [95% CI 11·0–33·3]; adjusted hazard ratio [HR] 0·45 [95% CI 0·33–0·62]; p vs 85 [41%] of 208; adjusted HR 1·63 [95% CI 0·67–3·91]; p=0·28). However, combination therapy was associated with lower mortality than was monotherapy in the high-mortality-score stratum (30 [48%] of 63 vs 64 [62%] of 103; adjusted HR 0·56 [0·34–0·91]; p=0·02), but not in the low-mortality-score stratum (17 [24%] of 72 vs 21 [20%] of 105; adjusted odds ratio 1·21 [0·56–2·56]; p=0·62). Interpretation Appropriate therapy was associated with a protective effect on mortality among patients with BSIs due to CPE. Combination therapy was associated with improved survival only in patients with a high mortality score. Patients with BSIs due to CPE should receive active therapy as soon as they are diagnosed, and monotherapy should be considered for those in the low-mortality-score stratum. Funding Spanish Network for Research in Infectious Diseases, European Development Regional Fund, Instituto de Salud Carlos III, and Innovative Medicines Initiative.

The role of phosphate in kidney disease

Abstract: The importance of phosphate homeostasis in chronic kidney disease (CKD) has been recognized for decades, but novel insights - which are frequently relevant to everyday clinical practice - continue to emerge. Epidemiological data consistently indicate an association between hyperphosphataemia and poor clinical outcomes. Moreover, compelling evidence suggests direct toxicity of increased phosphate concentrations. Importantly, serum phosphate concentration has a circadian rhythm that must be considered when interpreting patient phosphate levels. Detailed understanding of dietary sources of phosphate, including food additives, can enable phosphate restriction without risking protein malnutrition. Dietary counselling provides an often underestimated opportunity to target the increasing exposure to dietary phosphate of both the general population and patients with CKD. In patients with secondary hyperparathyroidism, bone can be an important source of serum phosphate, and adequate appreciation of this fact should impact treatment. Dietary and pharmotherapeutic interventions are efficacious strategies to lower phosphate intake and serum concentration. However, strong evidence that targeting serum phosphate improves patient outcomes is currently lacking. Future studies are, therefore, required to investigate the effects of modern dietary and pharmacological interventions on clinically meaningful end points.

A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study.

Abstract: Background Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients Methods All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution Results Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (166% versus 278%) The most frequent symptoms were headache (894%) and visual field defects (289%) in men, and headache (861%) and epileptic seizures (268%) in women Gynecological factors comprised the largest group in women, in particular puerperium (183%) Prothrombotic conditions (264%), mainly methylenetetrahydrofolate reductase mutation (63%) and Factor V Leiden mutation (51%), were the most common etiologies in both genders 81% of patients had infection-associated and 52% had malignancy-related etiology that was significantly higher in men and older age group Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score Epileptic seizures had no effect on prognosis Conclusions Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium Oral contraceptive use was not a prevalent risk factor in our cohort Malignancy, older age, and hemorrhagic infarcts had worse outcome

Long-Term Outcome of Steroid-Resistant Nephrotic Syndrome in Children.

Abstract: We investigated the value of genetic, histopathologic, and early treatment response information in prognosing long-term renal outcome in children with primary steroid-resistant nephrotic syndrome. From the PodoNet Registry, we obtained longitudinal clinical information for 1354 patients (disease onset at >3 months and <20 years of age): 612 had documented responsiveness to intensified immunosuppression (IIS), 1155 had kidney biopsy results, and 212 had an established genetic diagnosis. We assessed risk factors for ESRD using multivariate Cox regression models. Complete and partial remission of proteinuria within 12 months of disease onset occurred in 24.5% and 16.5% of children, respectively, with the highest remission rates achieved with calcineurin inhibitor-based protocols. Ten-year ESRD-free survival rates were 43%, 94%, and 72% in children with IIS resistance, complete remission, and partial remission, respectively; 27% in children with a genetic diagnosis; and 79% and 52% in children with histopathologic findings of minimal change glomerulopathy and FSGS, respectively. Five-year ESRD-free survival rate was 21% for diffuse mesangial sclerosis. IIS responsiveness, presence of a genetic diagnosis, and FSGS or diffuse mesangial sclerosis on initial biopsy as well as age, serum albumin concentration, and CKD stage at onset affected ESRD risk. Our findings suggest that responsiveness to initial IIS and detection of a hereditary podocytopathy are prognostic indicators of favorable and poor long-term outcome, respectively, in children with steroid-resistant nephrotic syndrome. Children with multidrug-resistant sporadic disease show better renal survival than those with genetic disease. Furthermore, histopathologic findings may retain prognostic relevance when a genetic diagnosis is established.

The Firm-Specific Determinants of Corporate Capital Structure: Evidence from Turkish Panel Data

Abstract: The purpose of this study is to carry out an empirical testing, using dynamic panel data methodology, to analyze the impact of firm specific characteristics on the corporate capital structure decisions of Turkish firms The sample covers 123 Turkish manufacturing firms listed on the Istanbul Stock Exchange (ISE) and the analysis is based on the year-end observations of ten consecutive years running from 1993-2002 In this study, the panel data methodology is used and six variables – size, profitability and growth opportunities in plant, property and equipment, growth opportunities in total assets, non-debt tax shields and tangibility – are analyzed as the firm specific determinants of the corporate capital structure This work contributes to the existing body of literature in the way that all of the independent variables of the study are significant determinants for the capital structure decisions of Turkish firms Our analysis shows that variables of size and growth opportunity in total assets reveal a positive association with the leverage ratio, however, profitability, growth opportunities in plant, property and equipment, non-debt tax shields and tangibility reveal inverse relation with debt level

Multimodality imaging in restrictive cardiomyopathies: an EACVI expert consensus document: In collaboration with the 'Working Group on myocardial and pericardial diseases' of the European Society of Cardiology Endorsed by the Indian Academy of Echocardiography

Abstract: Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM.

EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review.

Abstract: The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC.

The effect of cultural distance on medical tourism

Abstract: This study analyses the relationships between the origin countries of international patients and their cultural distance from the destination country in the context of medical tourism. A novel panel dataset is used, covering 109 origin countries whose citizens came to Turkey and received medical treatment during 2012–2014. After accounting for control variables such as religious similarity, Turkish diaspora in the origin country, physical distance, GDP per capita and number of inbound tourists, the study finds that cultural distance has an impact on the choice of destination for medical tourism. This impact persists at the medical specialty level.

The roles of polyamines in microorganisms.

Abstract: Polyamines are small polycations that are well conserved in all the living organisms except Archae, Methanobacteriales and Halobacteriales. The most common polyamines are putrescine, spermidine and spermine, which exist in varying concentrations in different organisms. They are involved in a variety of cellular processes such as gene expression, cell growth, survival, stress response and proliferation. Therefore, diverse regulatory pathways are evolved to ensure strict regulation of polyamine concentration in the cells. Polyamine levels are kept under strict control by biosynthetic pathways as well as cellular uptake driven by specific transporters. Reverse genetic studies in microorganisms showed that deletion of the genes in polyamine metabolic pathways or depletion of polyamines have negative effects on cell survival and proliferation. The protein products of these genes are also used as drug targets against pathogenic protozoa. These altogether confirm the significant roles of polyamines in the cells. This mini-review focuses on the differential concentrations of polyamines and their cellular functions in different microorganisms. This will provide an insight about the diverse evolution of polyamine metabolism and function based on the physiology and the ecological context of the microorganisms.

Ly6Chi inflammatory monocytes promote susceptibility to Leishmania donovani infection.

Abstract: Ly6Chi inflammatory monocytes (iMO) are critical for host defense against toxoplasmosis and malaria but their role in leishmaniasis is unclear. In this study, we report a detrimental role of Ly6Chi iMOs in visceral leishmaniasis (VL) caused by Leishmania donovani. We demonstrate that Ly6Chi iMOs are continuously recruited into the spleen and liver during L. donovani infection and they are preferential targets for the parasite. Using microarray-based gene expression profiling, we show that Ly6Chi iMOs isolated from the infected liver and spleen have distinct phenotypic and activation profiles. Furthermore, we demonstrate that blocking the recruitment of Ly6Chi iMOs into the liver and spleen during L. donovani infection using a CCR2 antagonist reduces the frequency of the pathogenic IFN-γ/IL10 dual producer CD4+ T cells in the spleen and leads to a significant reduction in parasite loads in the liver and spleen. Using STAT1-/- mice we show that STAT1 is critical for mediating the recruitment of Ly6Chi iMOs into organs during L. donovani infection, and adaptive transfer of wild type Ly6Chi iMOs into STAT1-/- recipients renders them susceptible to disease. Our findings reveal an unexpected pathogenic role for Ly6Chi iMOs in promoting parasite survival in VL and open the possibility of targeting this population for host-directed therapy during VL.

Follow-up results of patients with ADCK4 mutations and the efficacy of CoQ10 treatment

Abstract: ADCK4-related glomerulopathy is an important differential diagnosis in adolescents with steroid-resistant nephrotic syndrome (SRNS) and/or chronic kidney disease (CKD) of unknown origin. We screened adolescent patients to determine the frequency of ADCK4 mutation and the efficacy of early CoQ10 administration. A total of 146 index patients aged 10–18 years, with newly diagnosed non-nephrotic proteinuria, nephrotic syndrome, or chronic renal failure and end-stage kidney disease (ESKD) of unknown etiology were screened for ADCK4 mutation. Twenty-eight individuals with bi-allelic mutation from 11 families were identified. Median age at diagnosis was 12.4 (interquartile range [IQR] 8.04–19.7) years. Upon first admission, all patients had albuminuria and 18 had CKD (6 ESKD). Eight were diagnosed either through the screening of family members following index case identification or during genetic investigation of proteinuria in an individual with a history of a transplanted sibling. Median age of these 8 patients was 21.5 (range 4.4–39) years. CoQ10 supplementation was administered following genetic diagnosis. Median estimated glomerular filtration rate (eGFR) just before CoQ10 administration was 140 (IQR 117–155) ml/min/1.73m2, proteinuria was 1,008 (IQR 281–1,567) mg/m2/day. After a median follow-up of 11.5 (range 4–21) months following CoQ10 administration, proteinuria was significantly decreased (median 363 [IQR 175–561] mg/m2/day, P=0.025), whereas eGFR was preserved (median 137 [IQR 113–158] ml/min/1.73m2, P=0.61). ADCK4 mutations are one of the most common causes of adolescent-onset albuminuria and/or CKD of unknown etiology in Turkey. CoQ10 supplementation appears efficacious at reducing proteinuria, and may thereby be renoprotective.

Management of Hepatocellular Carcinoma: Prevention, Surveillance, Diagnosis, and Staging.

Abstract: More than 600 000 people die from hepatocellular carcinoma each year. Worldwide, research on the disease needs to be intensified in both the medical and pharmaceutical fields, with a focus on providing help to geographic areas where resources are limited. Treatment approaches depend on the stage of the disease at diagnosis and on access to complex treatment regimens. However, advanced disease is not curable, and treating these patients is expensive and only marginally effective for increasing quality-adjusted life-years. Although the Milan criteria are often used to determine which patients will benefit from liver transplantation, many centers have their own criteria for patient selection. According to criteria developed by Baskent University in Ankara, Turkey, patients with hepatocellular carcinoma and a cirrhotic liver but without extrahepatic disease should be candidates for liver transplant when possible, and living-donor liver transplant should be considered as an alternative rescue therapy for many of these patients. Tumor size and number should not be the sole criteria for excluding liver transplant. Although significant vascular invasion and extrahepatic dissemination definitely indicate major tumor dissemination, until sensitive tests for measuring circulating tumor cells are developed, we continue to recommend liver transplant regardless of tumor size and number. Various locoregional therapies for hepatocellular carcinoma are used before transplant to prevent tumor progression and to decrease the risk of recurrence after transplant. In turn, response to locoregional therapy to decrease tumor stage in hepatocellular carcinoma may be an indicator of tumor behavior and may determine a patient's selection for liver transplant. The delivery of healthcare services for hepatocellular carcinoma could be improved by developing centers of excellence. Concentrating medical care in this way can lead to an increased level of expertise so that resections are performed by surgeons who understand liver disease and the limitations of these and other procedures.

Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort.

Abstract: Background There is little information about the efficacy of active alternative drugs to carbapenems except beta-lactam/beta-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) The objective of this study was to assess the outcomes of patients with BSI due to ESBL-E who received empiric therapy with such drugs (other active drugs [OADs]) or carbapenems

Obesity and oxidative stress in patients with different periodontal status: a case-control study.

Abstract: Background and Objective Obesity has become an important global health concern as obesity-associated adiposity is supposedly related to systemic immunologic and inflammatory alterations. The aim of this study was to evaluate the effects of obesity on periodontally healthy and diseased tissue according to the changes in malondialdehyde (MDA), protein carbonyl (PC) and total antioxidant capacity (TAOC) levels in gingival crevicular fluid as biomarkers of oxidative stress (OS). Material and Methods The study sample comprised systemically healthy normal-weight (n = 45) and obese (n = 48) adults. Obesity was diagnosed according to body mass index, waist circumference and waist/hip ratio. Periodontal status was evaluated according to plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level. Participants were distributed among six groups according to obesity and periodontal status, as follows: normal weight+periodontally healthy (NH); normal weight+gingivitis (NG); normal weight+generalized chronic periodontitis (NCP); obese+periodontally healthy (OH); obese+gingivitis (OG); and obese+generalized chronic periodontitis (OCP). MDA, PC and TAOC levels were measured using ELISA. Results The MDA and PC levels in gingival crevicular fluid varied among groups, as follows: NCP > NG > NH (p OG > OH (p < 0.01). Conversely, the levels of TAOC in gingival crevicular fluid varied as follows: NCP < NG < NH (p < 0.01) and OCP < OG < OH (p < 0.01). Paired comparisons conducted according to periodontal status showed MDA and PC levels to be higher, and TAOC levels to be lower, in the OCP group than in the NCP group, in the OG group than in the NG group and in the OH group than in the NH group. However, only the differences between the OCP and NCP groups were significant (p < 0.01). In both obese and normal-weight individuals, clinical assessments showed significant, positive correlations with MDA and PC levels and negative correlations with TAOC levels (p < 0.01). Conclusion Obesity may influence periodontal tissue destruction and disease severity by increasing the level of oxidative stress in the presence of periodontal disease.

Predictors of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock.

Abstract: Background ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) remains as an unresolved condition causing high morbidity and mortality despite advances in medical treatment and coronary intervention procedures. In the current study, we evaluated the predictors of in-hospital mortality of STEMI complicated with CS. Methods In this retrospective study, we evaluated the predictive value of baseline characteristics, angiographic, echocardiographic and laboratory parameters on in-hospital mortality of 319 patients with STEMI complicated with CS who were treated with primary percutaneous coronary intervention. Patients were divided into two groups consisting of survivors and non-survivors during their index hospitalisation period. Results The mortality rate was found to be 61.3% in the study population. At multivariate analysis after adjustment for the parameters detected in univariate analysis, chronic renal failure, Thrombolysis In Myocardial Infarction (TIMI) post percutaneous coronary intervention (PCI) ≤2, plasma glucose and lactate level, blood urea nitrogen level, Tricuspid Annular Plane Systolic Excursion (TAPSE) and ejection fraction were independent predictors of in-hospital mortality. Conclusions Apart from haemodynamic deterioration, angiographic, echocardiographic and laboratory parameters have an impact on in-hospital mortality in patients with STEMI complicated with CS.

Hypoxia and inflammation indicate significant differences in the severity of obstructive sleep apnea within similar apnea-hypopnea index groups.

Abstract: We determined whether hypoxia parameters are associated with C-reactive protein (CRP), mean platelet volume (MPV), white matter hyperintensity (WMH), and the severity of obstructive sleep apnea (OSA), and also evaluated whether hypoxia parameters, CRP, MPV, and WMH differ in patients with similar apnea-hypopnea index (AHI) scores. A total of 297 patients, who were evaluated using polysomnography, were assessed retrospectively. The measured hypoxia parameters included total sleep time with oxygen saturation 0.05). Above the hypoxia threshold (CT90 ≥ 10%) of CRP, MPV increased significantly and the presence of WMH increased twofold. These data suggest that increased hypoxia severity may mediate increased inflammation and activation of platelets and contribute to the pathogenesis of WMH in patients with OSA. In addition, patients with severe OSA may show significant variability in inflammation and vascular risk. Further prospective data are needed.

Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

Abstract: There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists’ antibiotic prescriptions in a diagnosis-based manner in Turkey. This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained “single diagnosis and at least one antibiotic.” The number of antibiotics per prescription was 1.01. “Periapical abscess without sinus” (28.1%), “dental examination” (20.7%), and “dental caries” (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate “cellulitis and abscess of mouth” diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, “amoxicillin + enzyme inhibitor” (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred “amoxicillin + enzyme inhibitor” prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

IROA: International Register of Open Abdomen, preliminary results

Abstract: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org . Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogota-bag seem to improve results. ClinicalTrials.gov NCT02382770

The preoperative albumin level is an independent prognostic factor for optimally debulked epithelial ovarian cancer.

Abstract: A low albumin level has been reported to be a prognostic factor for various cancers. The aim of this study was to determine the association between preoperative serum albumin level and survival in patients with epithelial ovarian cancer (EOC). Records of 337 patients with EOC that underwent optimal cytoreductive surgery were retrospectively reviewed. Threshold albumin level was planned as 32.5 g L−1 due to the statistical analyses. Mean overall survival was 51.5 months. Area under the ROC curve was found statistically significant for the discriminative role of albumin for survival outcome (AUC = 0.857, 95% CI 0.813–0.90, P < 0.001). The best cut-off point for albumin was determined as 32.5 g L−1. The sensitivity rate, specificity rate, positive and negative predictive values, and accuracy rate for this cut-off level were found 67.2, 91.2, 81.2, 83.1, and 82.5%, respectively. Preoperative hypoalbuminemia was noted in 101 (30.0%) of the patients, of which 6.2% had an albumin level <25 g L−1. The albumin level was independently and significantly associated with overall survival (HR 2.6; 95% CI 2.1–3.1; P < 0.001). Subgroup analysis showed that patients with an albumin level <32.5 and ≥32.5 g L−1 had mean estimated overall survival of 40.6 and 96.0 months, respectively. Age, stage, and presence of ascites were the other independent significant factors. The preoperative albumin level is an independent prognostic factor for overall survival in optimally debulked EOC patients. Further investigations about preoperative albumin level in prognostic models will contribute to the literature.

Physiological, Biochemical, and Transcriptomic Responses to Boron Toxicity in Leaf and Root Tissues of Contrasting Wheat Cultivars

Abstract: In this study, we examined physiological, biochemical, and transcriptomic responses to toxic boron (B) treatment in leaves and roots of two wheat cultivars in order to gain better insight into B response or tolerance mechanisms. Delayed development and reduced vigor caused by high B were not observed in leaves and roots of both cultivars. Length, wet weight, and dry weight were not markedly changed under B toxicity. In leaves, when compared to control, 995 and 892 genes were significantly expressed at least twofold under B toxicity in Atay and Bolal, respectively. In roots, expressions of 1248 and 957 genes were responsive to B toxicity in Atay and Bolal, respectively. In leaf and root tissues, B toxicity induced more genes related to protein degradation in Atay than those in Bolal. These differences in transcriptome were attributed to higher B accumulation in the sensitive cultivar which required high level of metabolic adjustment. B toxicity stress did not cause any significant change in photosynthetic activity and contents of proline and glycine betaine in both cultivars. Coordinately, we did not find any differentially expressed genes required for proline and glycine betaine metabolisms. Genes related to hormone signaling, kinases, transcription factors such as WRKY and MYB, and key enzymes in reactive oxygen species (ROS) scavenging mechanisms were differentially affected by B toxicity in both cultivars. Among commonly regulated genes in Atay and Bolal, glutathione S-transferase (GST) and NIP4;1 (nodulin-26-like intrinsic proteins) genes stand out as prominent actors in B stress response.

Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes.

Abstract: OBJECTIVE Preterm premature rupture of membranes (PPROM) is closely related with maternal and fetal complications. Therefore, early diagnosis is extremely important to provide maternal and fetal well-being. Many inflammatory markers have been evaluated for their ability to diagnose membrane rupture at early stages. We aimed to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and preterm premature membrane rupture. MATERIAL AND METHODS In this study, 121 pregnant women with PPROM and 96 age-matched pregnant women with spontaneous preterm labor who were admitted to our hospital between January 2014 and December 2015 were enrolled. Demographic data, complete blood cell count results, and neonatal outcomes were recorded. RESULTS The neutrophil and platelet counts were higher in the PPROM group (9948.4±3393.2 vs. 7466.1±1698.5/mm3 and 244.5±60 vs. 210.6±64.8/mm3, respectively, p 117.14 (p<0.001). CONCLUSION The PLR might be a cost effective, easy to use, and practical marker for the early diagnosis of PPROM, which can help to determine the appropriate waiting time for delivery and provide maternal and fetal well-being.

Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral.

Abstract: Anorganic bovine bone mineral (ABBM) is extensively used in the treatment of intra-bony defects. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with a simplified technique. Although certain studies have reported the use of PRF in the treatment of intra-bony defects, to date, none of them have evaluated its additive effects with ABBM. Therefore, a randomised, split-mouth clinical trial was conducted to compare healing of intra-bony defects treated with an ABBM-PRF combination with healing of those treated with ABBM alone. By using a split-mouth design, 15 paired intra-bony defects were randomly treated with either ABBM alone (control group) or ABBM-PRF combination (test group). Following clinical parameters and radiographical measurements were recorded at baseline and 6 months after treatment: plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), clinical attachment level (CAL), vertical bone loss, depth of defect and defect angle. Preoperative clinical and radiographical measurements were similar for the test and control groups. Statistically significant reductions in GI, PD, CAL, vertical bone loss, depth of intra-bony defect and widening of defect angle were detected after treatment in both groups. With respect to inter-group analysis, gain in CAL was significantly greater in the test group than in the control group, whereas no inter-group differences were observed in any other parameter. The results of this study indicate that both therapies are effective in the treatment of intra-bony defects.

Strong gravitational lensing by a charged Kiselev black hole

Abstract: We study the gravitational lensing scenario where the lens is a spherically symmetric charged black hole (BH) surrounded by quintessence matter. The null geodesic equations in the curved background of the black hole are derived. The resulting trajectory equation is solved analytically via perturbation and series methods for a special choice of parameters, and the distance of the closest approach to black hole is calculated. We also derive the lens equation giving the bending angle of light in the curved background. In the strong field approximation, the solution of the lens equation is also obtained for all values of the quintessence parameter $$w_q$$ . For all $$w_q$$ , we show that there are no stable closed null orbits and that corrections to the deflection angle for the Reissner–Nordstrom black hole when the observer and the source are at large, but finite, distances from the lens do not depend on the charge up to the inverse of the distances squared. A part of the present work, analyzed, however, with a different approach, is the extension of Younas et al. (Phys Rev D 92:084042, 2015) where the uncharged case has been treated.